XVI] VIBRIO AND SPIRILLUM 413 



stools or of the contents of the lower ileum are crowded 

 with the comma bacilli, but in a considerable percentage 

 of typical cases this condition does not obtain ; there are 

 comma bacilli present, but they are mixed up sometimes to 

 a considerable amount with other bacteria. The epithelial 

 flakes detached and suspended in the contents of the 

 ileum, as well as the epithelial flakes loosened but not 

 quite detached from the mucous membrane, both of the 

 villi as also of the mouth of the Lieberkiihn's follicles, 

 contain comma bacilli as well as other bacteria. In sections 

 through the hardened mucous membrane of the ileum one 

 can find sometimes comma bacilli as well as other bacteria 

 within the tissue of the superficial mucosa denuded of 

 epithelium, in the cavity of the Lieberkiihn's follicles and 

 in spaces artificially produced by the loosening and detach- 

 ment of the epithelium of the Lieberkiihn's follicles, but 

 their presence in these localities is due to immigration from 

 the free surface into a disorganised mucous membrane, and 

 neither bears any relation to the onset nor to the severity of 

 the illness. Where the comma bacilli are scarce in the 

 intestinal contents, they, or other bacteria, are altogether 

 missed from the mucosa, where they are abundant in the 

 contents and on the surface they may penetrate from the 

 surface into the mucous membrane. 



In Figs. 168 and 169 film specimens of mucus flakes of 

 typical acute cases of Asiatic cholera are represented, in 

 which the cholera vibrios are present in fairly pure state, 

 and it will be noticed that as Koch has pointed out they are 

 arranged more or less in linear rows, " fish-in-stream arrange- 

 ment " ; this condition and distribution of comma bacilli in 

 mucus flakes of watery stools is so characteristic of cholera 

 asiatica that it alone is sufficient to make a correct diagnosis, 

 although as a matter of routine further experiments of culti- 



